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Week 8 seminar Urinary System Disorders and Calculating ‘Desired-Doses’ (chapter-28 and chapter-9) The Urinary System Made up of Organs which form & excrete urine (see Fig.28-1 on pg 585) (2) Kidneys (2) Ureters Bladder Urethra Common symptoms of Urinary System Disorders _________________ _________________ _________________ _________________ _________________ _________________ _________________ Common Side-effects of Rx’s for Urinary System Disorders Drying of secretions Drowsiness, dizziness, sedation Rash, hives, ‘urticaria’ GI effects (nausea, vomiting, diarrhea) Headache Discoloration of urine (not always related to a disorder, may be a normal side effect of medication, see Table 28-1, p.585) Urinary System DRUG therapy See Chart @ top of page-584 in Textbook ◦ ◦ ◦ ◦ ◦ ◦ Diuretics Anti-infective Urinary Tract Antiseptics Urinary Tract Antispasmodics Medications for overactive bladder Medications for enuresis DIURETICS Increases diuresis (loss of water in the body) Used with cardiovascular meds to decrease load on the heart and decease BP Decreases edema Also causes loss of sodium, potassium and chlorides (next slide) Categorized by site of action: ◦ Thiazides ◦ Loop diuretics ◦ Osmotics Electrolyte Imbalance Effects Electrolyte level symptoms SODIUM high Edema, thirst, high temp, flushing low Stomach-cramps, vomiting, diarrhea high Abdominal-distension, diarrhea low Paralysis, weakness, muscle function high Anorexia, nausea, coma, weakness low Muscle-cramp/twitching, numbness/tingling of fingers, toes, lips high Flushing, sweating, low temp, cardiac depression low Abnormal heart rhythms, neurotoxicity POTASSIUM CALCIUM MAGNESIUM Urinary Tract Infections (UTI) Most common bacterial infection in the U.S. 10 – 20% of females have a UTI during lifetime E.Coli causes ~90% of all cultured UTI’s Upper UTI (______________) - symptoms include> *lower-back/flank pain *fever *headache *nausea/vomiting Lower UTI (______________) - symptoms include> *frequency *urgency *dysuria *hematuria *oliguria *incontinence Some causes of UTI’s Anything that results in urine being ‘held’ in the bladder (more common in females …sorry ladies!) If you gotta go … you BETTER go! Dietary factors – certain foods (see Box 28-1 Enlarged Prostate (males) – constricts the urethra, causing urine to be ‘retained’ in the bladder Female ‘Plumbing’ – due to the short length of urethra, and the proximity of the urethra, vagina, and the anus p587) UTI - Drug Therapy Antibacterials (sulfa-drugs, trimethoprim) kills bacteria in the urine and systemically Antiseptics (Macrobid, methenamine) antibiotic activity ONLY in the urine ! Analgesics (Pyridium, AZO-standard otc) by topical and local anesthesia on the lining of the urinary-tract --- Study --- Table 28-3 on page 589 UTI – RX Patient Education Sulfonamides (sulfa-drugs) – take on emptystomach with a full glass of water – DRUGS OF CHOICE FOR TX OF UTI Drink plenty of water throughout the day (eight to ten 8-oz glasses if on a sulfa-drug) If taking sulfa-drug, avoid prolonged exposure to sunlight, unless using a good sunscreen ! Complete entire course of UTI drug treatment … even if symptoms improve !!! UTI – RX Patient Education (Cont.) Pyridium (phenazopyridine) – changes urine color to orange-red color! May stain clothing Cranberry juice, Vit-C, prunes make urine more acidic, making antiseptics more effective Carbonated drinks, citrus fruits make urine less acidic, making antiseptics less effective ! FEVER after starting the drugs may be a sign of a drugreaction, not a UTI-symptom Small, spastic-like bladder (‘tiny-tank’) that empties automatically when filled to a certain point Tofranil (imipramine) – anti-depressant DDAVP (desmopressin) – an anti-diuretic that actually increases the reabsorption of water ----available as a Nasal-spray, or tablet Time for Calculating Doses (nonparenteral) the main 3 calculation methods --- Ratio-and-Proportion method --- Formula-Method --- Dimensional-analysis Choose the ONE method that you’re most comfortable with … … and stick with it ! Why go with ONE method ? …you will become very familiar with your ‘chosen’ method … this will reduce the chance of medication errors that may occur from switching between calculation methods ! Basic Rules for Confident Calculating Always check UNIT’s (numerator/denominator) Always work the problem ON PAPER, even the math seems EASY Check and RE-CHECK all Decimals, Fractions LOOK at the RESULT! …does it look reasonable, does it make sense? Take ONE LAST LOOK to make sure you calculated dose in the correct units Box 9-1(p.166) Dosage-forms Know which types of dosage-forms can be divided, halved, altered Scored tablets – okay to break Oral – syrups and liquids – okay to alter Timed-release (sustained, delayed) – DO NOT BREAK or ALTER THESE ! … this can significantly change the rate of the drug’s dissolution (dissolving) and its absorption “labeling” the parts of the problem “DA or A” = dose-available, what is ‘on-hand’ “DO or O” = dose-ordered, what you ‘want’ “DF or V” = dosage-form or vehicle, of the ‘onhand’ “DG or X” = dose-to-give, this is the unknownamount of the on-hand drug that we are calculating … this is the ‘X’ that we are solving for. Ratio and Proportion can be written with : or / Units of measurement must match … numerator : denominator or numerator / denominator Ratio examples: 60-minutes : 1-hour or 60-minutes / 1-hour Proportion examples: 60min : 1hr = 120min : 2hr or 60min / 1hr = 120min / 2hr Let’s try one!: how many minutes in 2.5 hours ? Ratio and Proportion How many minutes in 2.5 hours ? 1. 2. 3. 4. we are looking for x min / 2.5 hours we know that 60 min / 1 hour so set-up the problem as 60min / 1 hr = X min / 2.5hr now multiply (means x extremes or cross-multiply) X x 1 = 2.5 x 60 X = 150 minutes 5. 6. 150 minutes … our final answer To check your answer: replace x with your answer in the original set up and multiply. If both sides of the equation match, you are correct 60min / 1 hr = 150 min / 2.5hr 150 min x 1 = 60 x 2.5 150 = 150 Your Turn: How many teaspoons in 5 tablespoons? 3 tsp : 1 tbsp 3 tsp : 1 tbsp = X tsp : 5 tbsp 3 x 5 = 1 x X 15 = X Check answer: 3 x 5 = 15 x 1 15 = 15 Formula Method O /A xV = X “DA or A” = dose-available, what is ‘on-hand’ “DO or O” = dose-ordered, what you ‘want’ “DF or V” = dosage-form (vehicle), of the ‘on-hand’ “DG or X” = dose-given, this is the unknownamount of the on-hand drug that we are calculating Always check that the strengths of the drug-ordered (O) and the drug-available (A) are in the same-unit-of-measure! Formula Method cont. Look at page-171 Example #3, then Example #4 Ask yourself … (also, page-171) --what the Dr. ordered (O)? --what strength is available (A)? --what is the unit of measure (V)? --how much do we need to give (X)? Let’s Do an Example Physician Ordered: warfarin 20 mg po daily On hand: warfarin 5 mg tabs How many tabs will you give daily? O/A x V = x 20 mg / 5 mg x 1 tab = x 4 x 1 tab = x 4 tabs = x Try one in liquid form…. Dr Smith orders 2 mg of Valium IV to a patient with seizure activity.You have a 5 mL vial that contains 10 mgs of Valium. (10mg/5mL). How many mLs are you going to draw up? Formula Method: 2 mg / 10 mg x 5 mL = X 0.2 x 5 mL =X 1 mL =X Ratio/Proportion Method 10 mg : 5 mL = 2 mg : X mL 10 x X = 5 x 2 10 X = 10 X = 1 mL Check Answer: 2 mg / 10 mg x 5 mL = 1 mL 10 mg : 5 mL = 2 mg : 1 mL 0.2 10 x 1 x 5 mL = 1 mL 1 mL = 1 mL = 5 10 = 10 x 2 Dimensional Analysis Does not require conversion between measurement systems first X always goes on the left side of the = the ‘factors’ go on the right side of the = ◦ the first factor is always what was ordered write the factors so that all “units” can be cancelled except for the one you want your answer to have X = ordered 1 x available x conversion factor (if needed) Example using DA: Dr Smith orders 2 mg of Valium IV to a patient with seizure activity. You have a 5 mL vial that contains 10 mgs of Valium. (10mg/5mL). How many mLs are you going to draw up? X = 2 mg 1 X = 2 5 mL 10 mg x 5 mL 10 X = 10 mL 10 X = x 1 mL 1 More Dimensional Analysis (with a conversion) Dr Jones ordered Levaquin 1g po q 12 h; you have 500 mg tabs. How many tabs will you give daily? X=1g 1 x 1 tab 500 mg X = 1 x 1 tab x 1000 500 x 1 X= X= 1000 500 2 tabs x 1000 mg 1g Converting Grains (gr) to Milligrams (mg) Grains is written totally different than other measurements: the amount is written AFTER the unit and written in Roman Numerals not standard numbers Examples: gr i = 1 grain gr ii = 2 grains gr v = 5 grains gr ss = ½ grain (or 0.5 grain) gr ¼ = ¼ grain (or 0.25 grain) To convert grains to milligrams use the conversion of 1 gr = 60 mg Convert the following gr to mg gr v = _________ mg gr ss = _________ mg gr ¼ = _________ mg gr iss = ________ mg Answers: gr v = 300 mg (1 gr : 60 mg = 5 gr : X mg) 1 x X = 60 x 5 X = 300 gr ss = 30 mg (1 gr : 60 mg = 0.5 gr : X mg) 1 x X = 60 x 0.5 X = 30 gr ¼ = 15 mg (1 gr : 60 mg = 0.25 gr : X mg) 1 x X = 60 x 0.25 X = 15 gr iss = 90 mg (i=1 and ss=0.5) (1 gr : 60 mg = 1.5 gr : X mg) 1 x X = 60 x 1.5 X = 90 QUESTIONS ??????????????????????? ?????????????